Provider Demographics
NPI:1588956478
Name:LOPEZ, ROXANNE DIANE (LMT)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:DIANE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E PLAZA CIR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4924
Mailing Address - Country:US
Mailing Address - Phone:623-932-0637
Mailing Address - Fax:623-932-0750
Practice Address - Street 1:503 E PLAZA CIR DR
Practice Address - Street 2:SUITE B
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4924
Practice Address - Country:US
Practice Address - Phone:623-932-0637
Practice Address - Fax:623-932-0750
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-10183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist